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Lecture #6-1 Flashcards

1
Q

What can we learn from catheterization?

A

Information about intracardiac hemodynamics and coronary circulation by injecting radio-contrast substance

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2
Q

Name of catheter with balloon at end.

A

Swan-Ganz Catheter

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3
Q

CO is increased by… (2)

A

Symp. stimulation

Myocardial Hypertrophy w/ SV increase

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4
Q

CO is reduced by… (5)

A 
Arrythmias
Valvular insufficiency
Inc. afterload
Reduced contractility
Preload elecation beyond starling law
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5
Q

Name the Gold Standard for CO measurement.

A

The Fick Method

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6
Q

What happens in the Fick Method?

A

Measure Oxygen Consumption
Measure O in mixed venous blood
Measure O in arterial blood

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7
Q

Mixed venous blood oxygen equation

A

(2SVC+IVC)/3

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8
Q

Equation used with Fick’s Ingo

A

CO = (Oxygen Consumption)/Arteriovenous Oxygen Difference)

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9
Q

Equation for cardiac index.

A

CI = CO / Body Surface Area

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10
Q

Most commonly used method to measure CO?

A

Thermal Dilution

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11
Q

How does thermal dilution work?

A

Injection of cold saline
Degree of warming measured downstream
Area Under Curve = Flow In Pulmonary/LV Output

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12
Q

benefits of CO measurement with cold saline?

A

No recirculation bump

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13
Q

Alternative ways of measuring CO

A

Doppler Method

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14
Q

What measurements are performed in the doppler method?

A

Echo used to measure aortic root cross sectional area
ultrasound used to measure doppler shift/blood velocity

Flow = V X Area

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15
Q

Doppler velocity profile can also help estimate…

A

Inotropic State, Preload, and Afterload

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16
Q

Double alternative method of measuring CO?

A

3D Echo Ventriculography

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17
Q

How can intracardiac pressures be measured?

A

Swan-Ganz catheter

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18
Q

What is pulmonary capillary wedge pressure?

A

Catheter is passes into br. of Pulmonary Artery, Balloon expanded

Approximates Atrial Pressure

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19
Q

Intracardiac pressure measurements should be performed while patient is….

A

finishing expiration

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20
Q

Pulmonary Artery Occlusion Presure (PAOP) is ________ related to Pulmonary Capillary Wedge Pressure

A

Closely

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21
Q

Relationship of flow through tube to radius of tube?
to length of tube?
to viscosity?
to change in pressure?

A

r^4
Inverse
Inverse
Proportional

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22
Q

In Vascular System…Resistance= (equation)

Again with new words.

A

(MAP-MVP)/Blood Flow

(Pulm Art - Wedge Pressure) / Flow

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23
Q

Systemic Vascular Resistance =

A

(Pa-Pv)/CO

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24
Q

PVR =

A

(Ppulm-Pla) / CO

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25
With a constant CO, any change in resistance will....
Change the pressure drop across the circuit
26
Five examples of pressure drop...
``` Pulmonary Hypertension Systemic Hypertension Mitral Stenosis Aortic Stenosis Hepatic Portal Hypertension ```
27
Equation or Pulmonary Artery Pressure with elevated resistance.
PA - PAWP = CO x Rp = Differential | PA = PAWP + Differential
28
Perks of echocardiography?
Widely Available Inexpensive Performed at Bedside
29
Transthoracic M-Mode Echo used to observe...(3)
Mitral Valve Leaflets Myocardial Shortening Radial Thickening
30
Transthoracic 2-dimensional echo used to observe...
Pie shaped heart section
31
Why do 3D Echo?
Quantification of LV volume and EF | Quantification of Mitral Valve Area
32
Doppler echo is used to show?
Blood Turbulence and Flow | Ventricular Wall motion and valve function
33
Pressure gradient across a stenosis is ____ times the maximum velocity across the stenosis.
4 X the square of Vmax
34
What should you look for when nuclear imaging?
Hemodynamically significant coronary artery stenoses
35
What does gated radionuclide imaging show?
Visualization of heart chambers by detecting gamma emissions from blood after isotope injection Evaluates CAD, Valvular Heart Disease, Conjenital Heart Disease, Cardiomyopathy.
36
What does Radionuclide myocardial perfusion imaging (MPI) do?
Heart cells take up radionuclide (SPECT, Thallium) Shows regional variation in myocardial perfusion/viability Often done with stress test
37
Review Pics on 14
Pretty please.
38
Gold standard test for EJF?
MRI
39
What does PET imaging show?
Blood flow through specific regions of the heart. | Myocardial Metabolism
40
What is a CT?
Many X ras used in morphoogical analysis of an organ
41
What is an MRI?
Measures H1 activity when exposed to a large magnet.
42
What is the gold-standard for myocardial viability assessment?
PET scan
43
What is heard in the 4 heart sounds
S1 -- Closure of AV S2 -- Closure of Semilunar Valves S3 -- Rumble of distending ventricles pulling AV taut S4 -- Atrial Contraction
44
Distance between two S1 or two S2 sounds may indicate...
Right Bundle Branch Block
45
Who should have an audible S3?
People age 20-25
46
S3 sounds like? S4 sounds like?
S3 -- Tennessee | S4 -- Kentucky
47
Which patients do you hear S4 in?
Individuals with ventricles with low compliances.
48
What is an opening snap?
A sound from stenotic AV valves opening during diastole
49
When are murmurs normal?
Small children and exercise. | Blood flows through fast enough to generate turbulence.
50
Typical cause of murmurs?
Turbulent Blood Flow
51
How would you distinguish a regurg. vs a stenotic murmur?
Regurg would be heard with valves closed | Stenotic with valves open
52
Example of a systolic murmur? a diastolic murmur?
Mitral valve fails to close fully | Aortic valve fails to close fully
53
Another way of saying insufficient mitral valve?
Insufficient Mitral Valve
54
Aortic Valve Stenosis causes an increase in ____ pressure. Mitral valve stenosis causes an increase in ______ pressure.
Left Ventricular Pressure | Left Arterial Pressure
55
Mitral Valve regurg. causes ______ | Aortic Valve regurg causes ________
Tall V Wave in Arterial Pressure | Tall LVP, higher systolic (Austin Flint mid-diastolic Murmur)
56
Machinery Murmur relates to...
Patent Ductus Arteriosus
57
Review PV loops on Pg. 25
You'll be glad you did.
58
Four types of Systolic Murmur
Aortic Stenosis/Pulmonic Stenosis Atrial Septal Mitral Regurg/Tricuspid Regurg Mitral Valve Prolapse
59
Four Types of Diastolic Murmur
Aortic/Pulmonic Regurg Austin-Flint Mitral/Tricuspid Stenosis Patent Ductus Arterosus
60
Mitral Valve Prolapse Makes what sound?
Click
61
What is Austin Flint Mid Diastolic Murmur
In aortic regurg, blood pushes back agains mitral valve, creating a mitral stenosis effect
62
Murmur heard through systole and diastole?
Patent Ductus Arteriosus

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